Neurological approaches - evaluation and intervention Flashcards
task oriented approached to motor control training
remediation of client factors and environment to improve task performance
motor control is determined by interactive systems, behavioral tasks, and adaptive mechanisms
top down approach
Carr and Shepherd’s motor relearning program (MRP)
the person is an active participant whose goal is to relearn effective strategies for performing functional movement
learning general strategies for problem solving motor problems
no compensatory movements
principles of motor learning
acquisition of functional skills that can be generalized to multiple situations and environments
stages of motor learning:
1. skill acquisition stage (cognitive stage)
2. skill retention stage (carryover)
3. skill transfer (generalization)
overview of neurophysiologic frames of reference
- reflex responses come before controlled movement
- sensory input regulates motor output and sensation is necessary for movement to take place
- use of facilitation and inhibition techniques can improve motor performance
NDT/ the Bobath technique
development of normal patterns of posture and movement
postural reactions are a basis for movement control (righting, equilibrium, protective)
handling is the primary intervention to promote normal movement
proprioceptive neuromuscular facilitation (PNF)
patterns of movement, posture, sensory stimulation, visual cues, verbal commands
normal motor dev occurs in cervicocaudal and proximal-distal direction
early motor behavior is dominated by reflex activity
goal directed activity and facilitation
DIAGONAL patterns of movement (D1 flexion and extension, D2 flexion and extension)
good for Parkinson’s
Brunnstrom’s movement therapy
- facilitating recovery through a specific sequence
- 7 stages of motor recovery following hemiplegia
- developing synergies
Margaret Rood’s approach
- sensorimotor control is developmentally based
- treatment must begin at the person’s current level and progress sequentially
- 4 phases:
1. reciprocal inhibition/innervation (reflex governed)
2. co-contraction (agonist and antagonist contract at same time to provide stability)
3. heavy work (mobility on stability - proximal contract, distal is fixed)
4. skill (highest level of control)
Rood’s 8 ontogenic motor patterns
supine withdrawn, rollover, prone extension, neck contraction, prone on elbows, quadruped, standing, walking
motor response achieved is dependent on the type of sensory stimulation the therapist applies
Stability pattern and Rood – neck co contraction is the first one because it requires simultaneous activation of neck flexors and extensors
assessment for components of motor control
spasticity: quick stretch and measured on the ash worth scale
reflex testing: examples are grasp, flexor withdrawal, crossed extension, ATNR, STNR
qualitative descriptions of motor control
examples of motor control issues resulting in observable poor quality of movement
- intention tremor (at a target in space)
- dysmetria (under/over shooting)
- dyssynergia (breakdown in movement, not smooth)
- dysdiadochokinesia (cannot perform RAM)
- ataxia (loss of motor control)
- resting tremor
- rigidity
- bradykinesia
- akinesia (cannot initiate movements)
- athetosis (writhing)
- dystonia (distorted contraction)
- chorea (spastic involuntary of face and arms)
- hemiballismus (unilateral chorea)
assess subluxation
persons arm dangle
palpate space underneath acromion with your index finger
document the finger width
compare to other side
evaluation of oral motor dysfunction
ROM, strength, and tone of lips, cheeks and tongue
extra and intramural sensation
dentition (integrity of teeth, dentures)
oral control of bolus
swallow reflex
airway protection (gag)
primitive reflexes
cranial nerve testing
swallow studies
CN I
olfactory
smell
test: smell different things
CN II
optic
vision
eye-chart and visual field testing
